What Is An Extra-Schedular Rating? Do You Qualify?

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If you are planning to apply for VA benefits after having acquired a service-related disability, you are likely already aware that a rating schedule is used to determine how much compensation you will receive. What happens, though, when your disability presents in unexpected ways that are more severe than the rating available under the appropriate diagnostic code? Many veterans address this issue with the help of an experienced veteran’s disability lawyer by filing a claim for an extra-schedular rating.

What Is an Extra-Schedular Rating?

Schedular ratings are those that are awarded under the diagnostic codes that the VA uses for determining your level of compensation, assigning a rating to your condition that is based on its severity. Ratings are assigned in percentages, in increments of 10, from 0% disability to 100% disability with certain criteria that must be met in order to increase the percentage.

An extra-schedular rating is an evaluation awarded outside of the rating schedule due to an unusual manifestation of the particular condition that causes it to interfere more with the individual’s ability to be employed than that condition normally would or results in frequent hospitalization. The additional compensation is intended to replace wage loss resulting from disabilities that unexpectedly render a person unable to perform the tasks needed for his or her job. For example, if you suffered a service-connected ankle injury that has resulted in pain and swelling if you stand for more than 20 minutes even years after the injury occurred, you can ask for extra-schedular consideration as your injury is impairing your ability to work beyond what is contemplated by the rating schedule.

The Department of Veterans Affairs (VA) stated in the publication of its final rule on the matter in 2017, “an extra-schedular evaluation is to be applied to an individual service-connected disability when the disability is so exceptional or unusual that it makes application of the regular rating schedule impractical.”

Qualifications

In order to qualify for an extra-schedular rating, you must be able to prove not only that you have a disability that has received a specific rating, but that the schedular rating is inadequate based on the extreme symptoms that either substantially interferes with employment or result in frequent hospitalization. This is proven through evidence, which includes:

  • The information contained in your C-file. Your veteran’s claim file — also known as your C-file — contains all of the documentation that the VA is using to make a determination on your claim. It is important that you obtain a copy of your file and ensure that all of the information necessary to prove your condition is included. Missing information is often regarded as an absence of evidence, and can prevent you from getting the extra schedular rating.
  • Medical evidence, including a statement from your provider that notes that he or she has reviewed your entire file and has found that the severity of your condition is so severe that regular application of the rating schedule is insufficient. Your medical evidence should also include a record of the extreme manifestations of the condition that have caused you to seek a higher rating.
  • Lay evidence, including personal testimony and testimony from those close to you as to how the condition affects you on a regular basis.

The decision as to whether your condition warrants an extra-schedular rating is made by the VA Undersecretary for Benefits or the Director of Compensation Service by evaluating whether the rating criteria under which your disability is rated is appropriate for the symptoms you have experienced. However, even if the Undersecretary or the Director denies your claim, the Board of Veterans Appeals can still overrule their decision on appeal.

When Extra-Schedular Consideration applies to TDIU Claims

Extra-schedular consideration does not only apply to individual ratings; a veteran may also qualify for extra-schedular consideration when VA is considering a veteran’s claim for a Total Disability Rating based on Individual Unemployability (TDIU). This disability designation provides benefits at the 100-percent rate when a veteran is unable to maintain substantially gainful employment as a result of service-connected disabilities. If you were turned down for TDIU but you have a disability or combination of disabilities that render you unable to maintain employment, even if you don’t meet the schedular criteria, you can still request extra-schedular TDIU. Typically a veteran must have one disability rated at 60% or higher or two disabilities rated at 70% or higher with at least one of those disabilities rated at 40% or higher to seek entitlement to TDIU and receive the same level of benefits that an individual with a 100% disability rating would receive. However, extra-schedular TDIU is available to those veterans who do not meet the schedular criteria and have severe symptoms that are not contemplated by the rating schedule.

Let Us Help You Get the VA Benefits You Deserve

If you are applying for benefits and have experienced unusual or particularly severe symptoms of your disability or if you wish to appeal your rating based on your inability to work or maintain substantially gainful employment, our experienced veteran’s disability lawyers can provide the information and guidance you need.

Contact us for a free case review today.

 

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